Siblings of children and adolescents undergoing inpatient psychiatric treatment are the “hidden casualties” of mental health issues. They are also at risk for developing maladaptive behaviors.
With those concepts in mind, Emily Rubin, M.A., director of sibling support at UMass Medical School’s Eunice Kennedy Shriver Center, created a program entitled, “The Sibling Support Program: A Family-Centered Mental Health Initiative.”
Launched in 2011, to date, 900 siblings and parents have participated at partnering Boston-area hospitals and that number is growing.
“Family members are often left on their own to manage situations. The program is designed to build resiliency and decrease trauma,” Rubin said.
At collaborating sites, siblings ages five to 18 and adult caregivers of young patients meet separately one time in nearby rooms with trained professionals.
They enjoy a meal together and conversations ensue that are beneficial to all involved, Rubin noted.
“The kids talk about what it is like to grow up with someone with mental health issues,” Rubin explained. “They are dealing with so much – feelings of confusion, shame, anxiety. There is fear for their own safety as many have been exposed to physical and verbal aggression and witnessed suicide attempts…Hearing stories from other kids helps them to feel they are not alone.”
The young participants respond to a series of questions to encourage them to tell their stories.
And, they learn coping techniques from peers. For example, one boy may tell another that it is helpful to listen to music to de-stress.
Adult providers also furnish them with a list of helpful strategies and are at the forefront of encouraging the youth to talk about the “scary,” things happening at home.
“Kids develop a new language about what happens in their families. It’s hard to talk about,” Rubin said. “People struggle with that issue all of the time. Is it okay to tell others when your sibling is hospitalized?
“A lot of times, kids are told not to tell the truth and we try to undo that. There is a delicate balance between being honest while at the same time respecting privacy.”
Another component of the program is a mentor-run psycho-education group for parents.
“Many parents are exhausted by the time their kid reaches the hospital setting,” Rubin said. “This (group) gives them access to a person who walks the walk every day.”
The trained parent mentors educate caregivers about the impact of their child’s mental health issues on the siblings, introduce parenting strategies to build resiliency and help them access family stabilization resources outside of the hospital setting that may make more sense geographically, Rubin said.
“My hope is that these interventions decrease isolation and involve them in a community of parents,” Rubin added.
Another aspect of the program is that it serves as a training rotation for psychiatry interns. Exposing them to family-centered health care is a rare and important tool, the program director noted.
At Cambridge Health Alliance, for example, there are eight trainees – five residents, a post doctoral student, a social worker and an expressive art therapist.
The McLean Franciscan Mental Health Programs at Franciscan Hospital for Children has one clinical psychologist/coordinator, two pre-doctoral students from Northeastern University and a parent mentor involved. The sibling program started there three months ago.
“The kids in our unit are in very severe crisis,” said Ralph Buonopane, Ph.D., program director in McLean Franciscan’s child and adolescent mental health program. “It is bewildering, isolating, alienating experience for family members.”
Buonopane said the sibling program is successful because it builds a sense of belonging for siblings and parents and “helps chip away at the stigma,” they feel.
He called it one of the most rewarding support methods of which he’s been a part.
“Our philosophy of care throughout the hospital is to support the whole family and this (program) really fits that,” Buonopane said.
“We focus on family rather than the crisis of the child. It gives our trainees the opportunity to think from a strength-based approach.”